Is vaginal delivery after cesarean possible? 

Let's do it by steps! Scientific evidence shows that it is much safer for a woman to go into spontaneous vaginal labor in a second pregnancy having a previous cesarean section, rather than inducing another surgery, with evidence of positive outcomes also in relation to the baby._cc781905-5cde -3194-bb3b-136bad5cf58d_

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What are the risks?
The risk of a second C-section is greater than letting this woman go into labor! Most women will have a previous cesarean section, and this should not be a risk factor to contraindicate them going into labor spontaneously.

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There are few risks of performing a vaginal delivery after cesarean section - one of them is uterine rupture, which is related to the scar of the cut to remove the baby. However, the chances of this happening are minimal: from 0.5% to 1%, according to data from Fiocruz.

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As rare as they are, we cannot rule out the possibility of occurrence; therefore, a woman who has had two previous cesareans can discuss with her doctor and staff the possibility of a proof of labor.

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The risks of uterine rupture after one or two previous cesareans are very similar. It is important to individualize the recommendations for each case and patient, present the risks of each procedure and individually discuss the best alternative.

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Despite the low probability of uterine rupture, it must be remembered that, most of the time it occurs, the woman in labor and the baby show signs that she is heading for a uterine rupture, and at this moment it is essential that you are supported by a qualified team for early diagnosis and immediate adequate assistance.

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What is the safe interval to have a vaginal delivery after cesarean section?
No risk is 100% ruled out, so what the risks are should be discussed. After a cesarean, the risks are greater for a second cesarean than for a proof of labor. After two cesarean sections, the risks are similar, lower for the birth test.

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Fiocruz also states that, after an interval of 1 year and 8 months between births, it would be the best option to perform a vaginal delivery with fewer risks. In the case of uterine rupture, it is independent of the time between delivery. It is safe to have a vaginal delivery after a cesarean, regardless of the interval between deliveries, and the time between deliveries should not be a big deciding factor.

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I have two previous cesareans, now what?
The recommendation of the National Directive for Assistance to Normal Childbirth by Conitec (National Commission for the Incorporation of Technology in the SUS) is that vaginal delivery after cesarean section should take place even after two previous cesarean sections; that is, it reinforces that the best option is for the woman to go into labor.

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There are no specific publications showing the risks of labor after the third cesarean – but the document recommends that after three or more surgical deliveries, the woman has another cesarean.

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If you want to have a vaginal delivery after cesarean section, ask all your questions, talk to your obstetric team and your support network, and set up your birth plan. I'm here to help you through all stages of pregnancy.